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Prosthetic fitting, use, function, and satisfaction are important rehabilitation goals following lower-limb amputation. This study prospectively examined these outcomes in a cohort of individuals who underwent lower-limb amputation secondary to peripheral vascular disease and/or diabetes. A wide range of demographic, psychosocial, and comorbid medical data were evaluated at baseline in the perioperative period, which enabled an assessment of possible contributing factors and their effect on these outcomes. This cohort of subjects was then followed for a year following amputation by utilizing a wide spectrum of objective and validated self-report outcome measures. These study design characteristics make this investigation unique compared to prior studies examining similar outcomes following dysvascular lower-limb amputation [1–11].

A Comparison of Balloon-Expandable-Stent Implantation …

A is an artificial limb that replaces an arm missing below the elbow. Two main types of prosthetics are available. Cable operated limbs work by attaching a harness and cable around the opposite shoulder of the damaged arm. The other form of prosthetics available are arms. These work by sensing, via , when the muscles in the moves, causing an artificial hand to open or close. In the prosthetic industry a trans-radial prosthetic arm is often referred to as a "BE" or below elbow prosthesis.

A is an artificial limb that replaces a leg missing below the knee. Transtibial amputees are usually able to regain normal movement more readily than someone with a transfemoral amputation, due in large part to retaining the knee, which allows for easier movement. In the prosthetic industry a trans-tibial prosthetic leg is often referred to as a "BK" or below the knee prosthesis.

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Providing a satisfactory, functional prosthesis following lower-limb amputation is a primary goal of rehabilitation. The objectives of this study were to describe the rate of successful prosthetic fitting over a 12 mo period; describe prosthetic use after amputation; and determine factors associated with greater prosthetic fitting, function, and satisfaction. The study design was a multicenter prospective cohort study of individuals undergoing their first major lower-limb amputation because of vascular disease and/or diabetes. At 4 mo, unsuccessful prosthetic fitting was significantly associated with depression, prior arterial reconstruction, diabetes, and pain in the residual limb. At 12 mo, 92% of all subjects were fit with a prosthetic limb and individuals with transfemoral amputation were significantly less likely to have a prosthesis fit. Age older than 55 yr, diagnosis of a major depressive episode, and history of renal dialysis were associated with fewer hours of prosthetic walking. Subjects who were older, had experienced a major depressive episode, and/or were diagnosed with chronic obstructive pulmonary disease had greater functional restriction. Thus, while most individuals achieve successful prosthetic fitting by 1 yr following a first major nontraumatic lower-limb amputation, a number of medical variables and psychosocial factors are associated with prosthetic fitting, utilization, and function.

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To determine prosthetic use, subjects were asked at 4 and 12 mo if they had been fitted with a prosthesis. For those who had been fitted, they were asked, "On average, how many hours per day are you wearing your prosthesis?" and "On average, how many hours per day are you walking with your prosthesis?" We measured prosthetic function and satisfaction using the Trinity Amputation and Prosthesis Experience Scales (TAPES) at 12 mo only because only half of the subjects were fitted with a prosthesis at 4 mo (vs >90% at 12 mo). The TAPES includes nine subscales measuring psychosocial outcomes, activity restriction, prosthetic satisfaction, pain, and general health [22]. The activity restriction subscale is further divided into an athletic activity restriction, functional restriction, and social restriction–the higher the score, the higher the restriction, with scores ranging from 0 to 8. The prosthetic satisfaction subscale of the TAPES is divided further into aesthetic satisfaction (range: 4–20), weight satisfaction (range: 1–5), and functional satisfaction (range: 5–25) subscales. The aesthetic satisfaction subscale reflects contentment with cosmetic characteristics. The functional satisfaction subscale includes the areas of prosthetic usefulness, reliability, fit, comfort, and overall satisfaction. The weight satisfaction score is determined by only one question based on satisfaction with the weight of the prosthesis. Higher scores on these subscales are indicative of greater prosthetic satisfaction.

Satisfaction with a prosthetic limb is also an important consideration following amputation, and many different aspects of prosthetic-limb satisfaction might be considered. This study utilized the TAPES to assess prosthetic satisfaction in the domains of aesthetic satisfaction, weight satisfaction, and functional satisfaction. In this study, scores on these three prosthetic satisfaction subscales correlated well with scores on the general adjustment subscale of the TAPES as well as with the three activity restriction subscales. This finding supports good internal consistency of the TAPES instrument in our study. The subjects in our study reported overall moderate levels of satisfaction with their prostheses. Specifically, the level of functional satisfaction with their prosthesis at all amputation levels was rated at 19.2 ± 4.2 with a range of possible scores of 5 to 25. The aesthetic and weight subscale scores did not change over time, which is likely a reflection of the fact that these individuals kept their same prosthesis throughout the study period or that the provided prostheses were similar in weight and cosmetic appearance. The level of functional satisfaction with the prosthesis at the TM level was significantly greater than at the other major amputation levels. The focus of the majority of the literature on dysvascular amputation has been on the TT amputation level or above. This finding provides new information on potential merits of TM amputation relative to TT or higher levels of amputation, although final evaluation of the potential value of an amputation level must be viewed in a more comprehensive way. A recent publication has shown that TT amputation may be associated with a greater likelihood of mobility success than TM amputation [41].

The majority of prosthetic devices are for below the knee amputees an intimate socket fit will provide improved comfort and gait patterns. Prosthetic devices commonly use silicone, urethane or elastomeric gels fit directed to the residual limb and hold the prosthetic device with or without pin locks. Elevated vacuum socket use is also on the rise and the intimate fit provides better blood flow to the residue limb for greater limb health for the amputee.

The study population included in this investigation is important for a number of reasons. First, only individuals with amputations secondary to peripheral vascular disease and/or diabetes were included, in contrast to several published studies that studied samples of mixed etiologies. Additionally, 31 percent of the present sample had TM-level amputations. Previous investigations have focused to a greater extent on dysvascular subject populations, which were predominantly TT and TF amputees, and their relative frequencies differed from this investigation. Historical Medicare data from 1996 reveal a lower prevalence of TM amputation and a much higher percentage of amputations at the TF level [29]. This may reflect a more recent trend where revascularization procedures are performed with the goal of salvaging a more distal amputation level [30–31]. The baseline demographic, psychosocial, and comorbid medical characteristics of the amputee populations at each major amputation level were very similar (). The only exceptions were a significantly higher rate of diabetes with the TM amputation and a significantly higher rate of smoking in the TF population. Lastly, the subjects included in this investigation were undergoing their first major-limb amputation, had at least minimal ambulatory function, and had adequate cognitive function to participate in the data collection process. Using a comparatively healthy sample of amputees at baseline created an opportunity to understand prosthetic fitting, use, satisfaction, and function among a sample of individuals who were optimal candidates for prostheses. This allowed us to examine some of the less well-studied biopsychosocial influences that affect prosthesis use above and beyond the more traditional physical factors.

"Blood makes noise." —Susanne Vega

In the prosthetic industry a trans-tibial prosthetic leg is often referred to as a "BK" or below the knee prosthesis while the trans-femoral prosthetic leg is often referred to as an "AK" or above the knee prosthesis.Other, less prevalent lower extremity cases include the following:Socket technology for lower extremity limbs saw a revolution of advancement during the 1980s when Prosthetics, John Sabolich C.P.O., invented the Contoured Adducted Trochanteric-Controlled Alignment Method (CATCAM) socket, later to evolve into the Sabolich Socket.

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While most individuals achieve successful prosthetic fitting by 1 yr following a first major dysvascular lower-limb amputation, individuals with TF amputations were significantly less likely to achieve prosthetic fitting success at 1 yr. TF amputation, increased age, major depressive episode, and history of dialysis were associated with significantly less prosthetic ambulation. Higher social support was associated with greater prosthetic ambulation. These findings suggest that evaluation and management of depression and promotion of social support may have a positive effect on outcome. Further study will be required to determine whether or not treatment of depression and encouragement of social support can be modified significantly enough to improve prosthetic use. Subjects in this study who achieved prosthetic fitting were overall satisfied with their prostheses.